The Last Mile: reaching children in remote areas with life-saving treatment for malnutrition

Addis Ababa, Ethiopia

By Feven Getachew
Robe Ali
©UNICEF Ethiopia/2020/ Ephrem Tamiru
18 November 2020

Robe Ali is distraught as she walks to the nearest health center, her child straddled on her back.  In the last few days, her 3-year-old son Dita Bultume has not been the same. He has been playing and eating less, has lost weight, and has become irritable and anxious.

“Ever since my baby fell ill, I have been suffering a lot moving from one clinic to another,” she says. As she reaches the Elala health center in Fentale Woreda, Oromia Region, she is met by Fatima Hussein, a health extension worker who diagnoses her child with acute malnutrition.

Robe Ali
UNICEF Ethiopia/2020/ Ephrem Tamiru
Fatima is a health extension worker at Fentale woreda. She is 26 years old. She is weighing baby Dita’s body. She is measuring his height to calculate his body mass to check his nutritional status.

"You can easily identify them, they are thin, sparse, and have light colored hair and they show behavioral changes,” explains Fatima as she performs the Mid Upper Arm Circumference (MUAC) check on Dita and takes his weight and height. The answer Robe was hoping for came in the form of sachets of Ready-to-Use Therapeutic Food (RUTF) which she was given for her child’s treatment.

Ready-to-Use Therapeutic Food (RUTF), called ‘Nefis Aden’ by the local community, or “life saver”, provides hope for parents and healing for many children suffering from severe acute malnutrition (SAM). In 2020, it is expected that more than 570,000 children like Dita will have needed treatment for SAM due to the combined effects of desert locusts, climate change, and COVID-19.

COVID-19 has also created unprecedented challenges with mitigation measures such as the closure of schools, transport restrictions, and stay-at-home measures putting vulnerable children further at risk of malnutrition. At the end of 2019, for example, about one million children benefited from school feeding programmes across seven regions; school closures led to a decline in food intake and nutrition. In Addis Ababa, for instance, there were more than half a million children that were receiving school meals who were no longer receiving this support.

Because of COVID-19, together with the Government and partners, UNICEF is ensuring that RUTF is procured and distributed to the most remote regions to cover the needs of children.

“We introduced the last-mile distribution of RUTF due to COVID-19. We traditionally distribute RUTF to regional health bureaus who in turn distribute to the zones, from where it is distributed to the woredas (districts) and health posts,” says Stanley Chitekwe, Chief of Nutrition at UNICEF Ethiopia. “With the last-mile distribution, we take the RUTF directly to health posts in 240 woredas to make sure that there are no delays or shortages of supply in these hard-to-reach, hotspot areas.”

UNICEF Warehouse
Health Center
Biruk Zenebe
(Pictured above RUTF loaded from UNICEF warehouse in Gergi, Addis Ababa and travels to a warehouse in Adama then taken on bike to Fentale Woreda.)

Dr Meseret Zelalem, Director of Maternal, Child Health, and Nutrition in the Ministry of Health says the last-mile distribution of nutrition commodities and supplies is intended to reach areas where demand for treatment is the greatest. “This is an excellent takeoff for us.”  

Thanks to support from the UK Government, European Union, and USAID, UNICEF was able to procure and distribute 30,000 cartons of RUTF for treating 30,000 children in Afar, Somali, and Oromia regions.

Since 2007, RUTF has been locally produced by Hilina Enriched Foods in partnership with UNICEF to sustainably meet the needs in Ethiopia. Local production made it easier to distribute and guarantee the required quantities of RUTF with the advent of COVID-19 when many countries went into lockdown.

“The value of local manufacturing [of RUTF] can be seen in many respects – one is the economic development of the country. We have 240 employees here at Hilina Foods but also the spin-off effects the supply chain of peanuts for example has for the 40,000 farmers involved in the production of peanuts,” says Hilina Belete, General Manager at Hilina Enriched Foods.

UNICEF Ethiopia/2020/ Ephrem Tamiru
Fatima Hussen is a health extension worker at Fentale district. She is 26 years old. She is supplying the packed RUTF at Fentale district to Robe.

“I am hoping for his full and speedy recovery so that he can play with his friends. That is all I want,” says Robe. She returns home with enough quantities of RUTF, comforted with the assurance that within 8-10 weeks, her child will get back to full health.